Boxes of semaglutide injection pens on a shelf inside a fridge at Durham Care Clinic and Pharmacy in Oshawa, Ont. Obesity experts say one solution to helping those who are prescribed the drug by their doctors but can’t access it financially is to have public health plans step in.EDUARDO LIMA/The Globe and Mail
When Bonnie Evoy entered her mid-60s, she unexpectedly and rapidly gained weight. She tried for two years to lose it, working out almost daily, even when sick or injured, and trying all sorts of diets.
Ms. Evoy, 67, said she felt “uncomfortable and desperate” and eventually asked her doctor about GLP-1 medications. She was prescribed the blockbuster drug Ozempic, but had to pay out of pocket because she didn’t fit the limited criteria for coverage.
Ms. Evoy, who lives in Ottawa, tried Ozempic for six weeks – not enough time for her to lose the weight she desired. She said it was too costly to continue.
“Since I was paying out of pocket, I didn’t renew my prescription,” she said. “It was just so expensive.”
Cost has been a major barrier for Canadians to access diabetes and obesity medications, leading patients like Ms. Evoy to stop treatment early or preventing others from starting altogether. But obesity experts say this problem could – and should – be alleviated with the coming tide of generics.
What will change in Canada when generic Ozempic hits the market, according to our reporters
Provinces and territories cover Ozempic only for people with Type 2 diabetes, although it is used off-label for weight loss. This means Canadians pay out of pocket or rely on private insurers.
About two-thirds of Canadians are covered by private health insurance. However, one-third get left behind, some relying on public plans to cover medications, including seniors and people who receive social assistance.
Obesity experts say one immediate solution to helping those who are prescribed the drug by their doctors but can’t access it financially is to have public-health plans step in. Yoni Freedhoff, medical director of the Bariatric Medical Institute in Ottawa, said that, as GLP-1s become cheaper, it is no longer a question of if provinces and territories should cover them but how.
Dr. Freedhoff said the positive impact of obesity medications is wide-ranging for individuals, the health system and employers, for example, cutting rates of absenteeism, addressing comorbidities and reducing disability claims and hospitalizations.
He estimates the annual cost of generic GLP-1s will likely be in the neighbourhood of $1,000 yearly per Canadian, but it could drop even lower after negotiations between manufacturers and public-health plans.
Public spending on prescriptions rises to $20.1-billion in 2024 as use of Ozempic grows
It is “impossible to imagine” that insurers won’t get on board soon, considering there is a strong economic argument that it will save them money over time, Dr. Freedhoff said. “I do think it’s an inevitability that there will be universal coverage, whether it’s through employers or through the government or both.”
Rates of obesity have risen in Canada to approximately one in three adults owing to a variety of factors, such as soaring grocery prices, sedentary lifestyles and poor nutrition. And while brand-name drugs, such as Ozempic and Wegovy, have revolutionized obesity and diabetes care, access is still constrained.
Medical organizations in Canada and abroad have long recognized obesity as a chronic condition, rather than a lifestyle choice. But policy makers have been reluctant to do the same – increasing barriers to treatment. Alberta is the only province to formally acknowledge obesity as such, yet it does not provide coverage for GLP-1s specifically for weight management.
Public and private coverage for these medications vary across Canada and are typically restricted to certain criteria, not weight loss alone. Currently, Ozempic is approved through Health Canada for the treatment of Type 2 diabetes and Wegovy, a higher-dose version, for chronic weight management.
In December, the pan-Canadian Pharmaceutical Alliance (pCPA), a body that represents provincial, territorial and federal drug plans, and Danish drugmaker Novo Nordisk broke off talks to cover Wegovy. The pCPA said the manufacturer had declined to negotiate Wegovy’s price.
The Canadian researcher whose discovery led to Ozempic is still making breakthroughs
Multiple versions of generic semaglutide, the active ingredient in Ozempic and Wegovy, are expected by the end of this year.
Sanjeev Sockalingam, the scientific director of Obesity Canada, said expanding coverage of semaglutide in public-health plans would help a “significant portion” of the population. But he said provinces will likely grapple with the eligibility criteria for coverage.
“Are they going to say you have to be at a higher BMI with more health conditions to be eligible and treat those who have more?” he said. “Or are some provinces going to be bolder and say we want to prevent things from happening upstream?”
Dr. Sockalingam said, in an ideal world, body mass index, or BMI, should be used as a screening tool but not as the sole metric. Other health comorbidities, such as diabetes or hypertension, should also be considered.
The Globe and Mail reached out to all provinces and territories, the majority of which said they are awaiting Health Canada approvals to make coverage decisions. A generic drug must be approved by Health Canada before it can be sold.
Manitoba did not respond to a request for comment.
How will cheaper versions of Ozempic tip the scales?
The federal government, which operates the Non-Insured Health Benefits Program for eligible First Nations and Inuit, said it is monitoring work by the pCPA.
Dr. Sabrina Kwon, medical director of the Alberta Obesity Centre North in Edmonton, said stigma and the upfront cost of covering obesity medications for a larger population are the likely reasons public coverage has so far been limited.
She said provinces must look at the bigger picture: These medications are not just for weight loss but have wide-ranging benefits that can reduce pressure on the health care system and society over all. Dr. Kwon said, for example, GLP-1s are highly effective in improving blood pressure, diabetes and cholesterol.
“Maybe you’re actually reducing the cost burden of this person having a heart attack in the future and then requiring the cardiac cocktail that comes along with it,” she explained.
Mauro Chies, chief executive of the pCPA, said in a statement that the organization will consider a new indication for Ozempic or Wegovy for negotiation if it receives a recommendation from Canada’s Drug Agency or Quebec’s equivalent.
“No generic semaglutide products have received Health Canada approval at this point. Should a manufacturer receive authorization, we’re ready to work with them on behalf of Canada’s public drug plans,” Mr. Chies said.
Dr. Sockalingam stressed that, as treatments become more accessible, other supports must be strengthened in concert, noting that risks associated with obesity medications include eating disorders and mental-health problems.